The Journal of the Japanese Association for Chest Surgery
Online ISSN : 1881-4158
Print ISSN : 0919-0945
ISSN-L : 0919-0945
Volume 12 , Issue 6
Showing 1-17 articles out of 17 articles from the selected issue
  • Eisaku Komori, Hiroshi Date, Shigeto Endou, Motoi Aoe, Kazunori Okabe, ...
    1998 Volume 12 Issue 6 Pages 646-651
    Published: September 15, 1998
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    We analyzed the patient selection process for lung volume reduction surgery (LVRS) for emphysema. Of 130 patients who visited our outpatient clinic over the period of 19 months, LVRS was performed in 44 (33.8%). Thirty-seven patients excluded without full evaluation had either insufficiently severe pulmonary function impairment, age over 75 years, no hyperinflation, severe pleural adhesion, or wrong diagnosis. Of the 79 patients who received full evaluation, 29 were excluded mainly because of morphological reasons, such as homogenous pattern and pleural adhesion. Age, pulmonary function and arterial blood gas analysis did not differ significantly between the patients receiving LVRS and those excluded after full evaluation. The forced expiratory volume in 1 second had improved by 44% in the 44 LVRS patients with no operative death.
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  • Makoto Sonobe, Masatsugu Nakagawa, Naoyuki Ikegami, Yuji Suzumura, Miy ...
    1998 Volume 12 Issue 6 Pages 652-659
    Published: September 15, 1998
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    We studied 70 patients undergoing limited operation for non-small cell lung cancer on long-term survival and local recurrence to clarify the validity and indication of this procedure. We had thought these patients unable to tolerate standard operation (lobectomy or pneumonectomy) because of their reduced cardiopulmonary functional reserve, age, request for preservation of quality of life, and so on. Of the 70 consisting of 25 squamous cell carcinomas, 41 adenocarcinoma, and 4 large cell carcinomas, 63 patients had clinical stage I disease, 3 patients stage II disease, 4 patients stage III disease. Overall 5-year survival was 50.5% for clinical stage I. In this stage patients with lesions less than 30 mm in diameter had a significantly better prognosis (5-year survival : 57.8% for ≤30 mm versus 38.0% for > 30 mm, p = 0.0087, Breslow-Gehan-Wilcoxon test). Segmentectomy led to some survival advantage compared to partial resection (5-year survival : 63.0% for segmentectomy versus 44.0% for partial resection, p = 0.1276). No significant difference in survival rate existed between squamous cell carcinoma and adenocarcinoma (5-year survival : 49.2% for squamous cell carcinoma versus 56.2% for adenocarcinoma, p = 0.4184). Over 5-year survival has not been observed in cases with clinical stage II, IIIA, IIIB, or large cell carcinoma. Forty-seven of 70 patients were identified on the presence or absence of local recurrence. Eighteen patients had squamous cell carcinoma, 26 patients adenocarcinoma and 3 patients large cell carcinoma. An original tumor over 20 mm in diameter or a shorter free margin (length from the edge of the original tumor to the resected surface) than 20 mm increased the local recurrence rate. The adenocarcinoma group had a significantly higher local recurrence rate than that of the squamous cell carcinoma group (11.1% for squamous cell carcinoma versus 42.3% for adenocarcinoma, p = 0.0427, Fisher's exact test). All three cases of large cell carcinoma developed local recurrence. We suggest that limited operation for non-small cell carcinoma seems effective for poor risk patients, especially with clinical stage I squamous cell carcinoma or adenocarcinoma although a sufficient free margin is essential. And we consider that a conservative resection for a non-compromised patient with clinical stage I non-small cell lung cancer needs at least the tumor being less than 20 mm in diameter and the assurance of a free margin longer than 20 mm with more strict criteria in case of adenocarcinoma.
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  • Yoshinobu Hattori, Shuichiro Sugimura, Tadashi Iriyama, Kouji Watanabe ...
    1998 Volume 12 Issue 6 Pages 660-666
    Published: September 15, 1998
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    Four patients with abnormal chest roentgenograms were evaluated and were proven intralobar pulmonary sequestration (IPS) at surgery. A 7-year-old boy and a 26-year old man had left lower IPS. Helical 3D-CT demonstrated the aberrant artery arising from the descending thoracic aorta and the draining pulmonary veins. They underwent left lower lobectomy. A 23-year-old man and a 35-year-old woman had right lower IPS. Helical 3D-CT demonstrated the aberrant artery arising from the abdominal aorta and the draining pulmonary veins. They were treated by left lower partial lobectomy. Helical 3D-CT is noninvasive, and provides accurate, three-dimensional information of the aberrant vascular supply of the pulmonary sequestration, which closely simulates the angiographic and surgical findings. Helical 3D-CT can replace angiography in the preoperative diagnosis of the pulmonary sequestration.
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  • Kenji Tetsuka, Shunsuke Endo, Tsuyoshi Hasegawa, Tsutomu Yamaguchi, Fu ...
    1998 Volume 12 Issue 6 Pages 667-671
    Published: September 15, 1998
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    A 57-year-old-man was referred to our hospital for systemic survey of malignancy because of markedly increased CEA plasma level to 150 ng/ml, but no symptoms. Chest computed tomograms revealed 2 × 3 cm-sized elliptical nodules adjacent to a 10 cm-diameter bulla in the right apical segment. No malignant cell was detected through transbronchial brushing cytology. On the right thoracotomy for exploration, the tumor was found in the hilar-sided wall of the bulla invading the azygous vein and right vagal nerve and the right thoracic wall. Right upper lobectomy, together with the resection of the azygos vein, vagal nerve, parietal pleura as well as mediastinal dissection, was done after the intraoperative diagnosis as adenocarcinoma through the incisional biopsy. Postoperative course was uneventful. Pathological diagnosis indicated poorly differentiated adenocarcinoma with high production of CEA. CEA level drastically decreased after operation and returned to normal range after adjuvant chemotherapy. When the CEA level is over 10 ng/ml, the presence of cancer should be cared.
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  • Mitsuhiro Kamiyoshihara, Toshikazu Hirai, Osamu Kawashima, Yasuo Moris ...
    1998 Volume 12 Issue 6 Pages 672-675
    Published: September 15, 1998
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    A 73-year-old woman was admitted to our hospital for further examination of an abnormal shadow of the chest roentgenogram. Chest computed tomograms showed a nodular tumor shadow in the right S9. Transbronchial lung biopsy yielded a diagnosis of well differentiated adenocarcinoma of the lung. With a diagnosis of primary pulmonary adenocarcinoma, a right lower lobectomy with mediastinal lymph node dissection was done. There was a 0.7 cm-sized mass in S7, which was not detected preoperatively. The pathological diagnosis was multiple primary lung cancer : adenocarcinoma of S9 and typical carcinoid of S7 of the right lung. Subcarinal lymph node had metastasis from the carcinoid tumor. The patient is alive without recurrence 10 months after. The present case is interesting at the point that typical carcinoid with smaller diameter metastasized to mediastinal lymph node despite greater diameter of adenocarcinoma. Additionally lobectomy with mediastinal lymph node dissection is necessary for typical carcinoid to be resected radically.
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  • Yasuyuki Shibata, Hiroshi Niwa, Takeshi Yamada, Hisanori Kani, Katsuto ...
    1998 Volume 12 Issue 6 Pages 676-680
    Published: September 15, 1998
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    A 56-year-old man was introduced to our hospital because of an abnormal shadow found on a chest X-ray. Chest CT and MRI revealed a cystic lesion in the anterior mediastinum, and a thymic cyst was clearly visible.
    The cyst was defined from the surrounding tissue by pneumomediastinum prior to VATS. It was completely situated in the anterior mediastinum without any connection to the neck. En -bloc resection of the left lobe of the thymus was performed. The lesion was pathologically diagnosed as a parathyroid cyst.
    The mediastinal parathyroid cyst was easily resected using VATS.
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  • Masaharu Nakade, Keijiro Kono, Hiroyoshi Watanabe, Hirokazu Tanaka
    1998 Volume 12 Issue 6 Pages 681-686
    Published: September 15, 1998
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    We report a case of obstruction of the superior vena cava caused by lung cancer. After chemo-radiotherapy, we performed right pneumonectomy and resected the superior vena cava (SVC). It was possible to perform complete resection of the carcinoma, and a 10-mm diameter polytetrafluoroethylene graft was inserted, end-to-end, between the azygos vein and the right appendage, because the bilateral innominate veins were obstructed by thrombus. It took about 11 hours after starting operation to reconstruct the bypass, and during the course of the operation, the symptoms of SVC syndrome grew worse. Immediately after the operation, it was impossible to remove the tracheal tube because of edema of the vocal cords. The next day the symptoms rapidly improved and on the fourth postoperative day, the tracheal tube was extubated. The patient has survived for 31 months since the operation and has no clinical findings of SVC syndrome. We conclude that in surgical cases with obstruction of the SVC caused by lung cancer, preoperative collateral venous flow is decreased by the skin incision, lymph node dissection, and other operative procedures, so that : 1. even if the SVC is totally obstructed, the time between the start of the operation and reconstruction of the SVC bypass should not be long, and 2. to our knowledge, azygos vein- right appendage internal bypass has not been reported previously, but in view of the patient's subsequent clinical course, this bypass appeared to be effective.
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  • Hiroshi Hosoda, Makoto Sunamori
    1998 Volume 12 Issue 6 Pages 687-690
    Published: September 15, 1998
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    A 29-year-old man with right pneumothorax admitted to our hospital. He was undergone Video assisted thoracic surgery (VATS) to treat his multiple blebs in his bilateral lung. We tried to avoid overlooking blebs and minor suturing mistakes with the dye spray method. Indigo carmine solution (0.1%) was sprayed on the lung through trocar with the double lumen spray tube. And then, the surface of the lung was washed out with normal saline. The blebs of the lung were clearly distinguished from normal tissue on the Video screen. It was very useful to investigate the presence of blebs and decide the proper suture line for auto-suturing apparatus.
    VATS is widely performed to treat spontaneous pneumothorax. However, some cases of recurrence of pneumothorax after VATS have been reported. We assume that pneumothorax recurs because some blebs are left or not properly sutured in the lung. The dye spray method of Indigo carmine solution may contribute to prevent the recurrence of pneumothorax.
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  • Shin Takabayashi, Takuya Komada, Motoshi Takao, Shoji Namikawa, Isao Y ...
    1998 Volume 12 Issue 6 Pages 691-696
    Published: September 15, 1998
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    A-31-old female was admitted to hospital because of fever and pointed out an abnormal shadow in her right pulmonary hilum on chest X-ray. Computed tomographic scan demonstrated a smooth-edged homogeneous posterior mediastinal mass measuring 6.0 × 5.9 × 3.2 cm in right side of the fifth and sixth thoracic vertebrae. Benign solitary fibrous tumor of the pleura was suspected by percutaneous needle biopsy. Video-assisted thoracoscopic removal was performed through three parts. After tumor dissection from the posterior mediastinum, we divided the tumor into 6 parts in the Endo-Catch®. They were removed from the chest cavity through the port with only 4cm skin incision. She made favorable progress after the operation.
    Although the indication of video-assisted thoracic surgery for benign tumors has recently expanded, the additional small thoracotomy is necessary for removing a large solid tumor. We reported a case with benign localized fibrous tumor of the pleura, which was successfully removed by using the Endo-Catch® and a minimizing skin incision.
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  • Michihiko Tajiri, Takamitu Maehara, Tatsushi Yamagata, Makoto Ishibash ...
    1998 Volume 12 Issue 6 Pages 697-701
    Published: September 15, 1998
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    We herein report thoracoscopic surgery for contra-lateral cancer in a patient who had previously undergone a pneumonectomy for lung cancer. A 67-year-old male, who had previously undergone a left upper lobectomy for adenocarcinoma of the lung (p-T1NOMO) 13 years ago and had also undergone a completion pneumonectomy for adenocarcinoma of the left lower lobe (p-T3NOMO) three years ago, was found to have a tumor in the S6 area of the right lower lobe. We suspected it to be either metastatic or primary lung cancer according to both the roentgenological findings of the lesion and the clinical history. We thus performed a thoracoscopic partial lung resection while successfully maintaining anesthesia using the selective lobar ventilation method and high frequency jet ventilation (HFJV). We completely collapsed the lower lobe in order to perform a safe thoracoscopic resection. The post operative course was uneventful. The respiratory function thereafter recovered to the pre-operative level by four weeks after surgery. The pathological diagnosis was moderately differentiated adenocarcinoma. Using the above described surgical method, less deterioration in the respiratory function tends to be observed than after other types of conventional surgery. In cases requiring a resection for contra-lateral lesions after a pneumonectomy this method may thus prove to be a useful alternative since it allows for a better preservation of patients' respiratory function.
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  • Masataka Koshika, Hiroyuki Oizumi, Tsukasa Fujishima, Masami Abiko, Yo ...
    1998 Volume 12 Issue 6 Pages 702-705
    Published: September 15, 1998
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    A 40-year-old female had twice suffered from right pneumothorax within 2 months that was related to the onset of menstruation, suggesting catamenial pneumothorax. Some punchout like small perforations was found in the central tendon of the diaphragm, and no bulla or bleb was found on the right lung. Thoracoscopic resection of the diaphragm was successfully performed using endostapeling and a cutting device. She has been asymptomatic for 14 months after operation.
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  • Akira Iyoda, Toshikazu Yusa
    1998 Volume 12 Issue 6 Pages 706-711
    Published: September 15, 1998
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    Primary pulmonary malignant lymphoma has been a comparatively rare disease, but reports are increasing because of the development of immunohistochemistrical examination and analysis of gene. We experienced a surgical case of primary pulmonary malignant lymphoma. A 69 year-old female was admitted to our hospital for mass survey of lung. There was an infiltrating shadow in the right middle lobe. We suspected it as lymphoma by transbronchial biopsy. The right middle lobectomy with mediastinal lymph node dissection was performed. Pathological diagnosis was malignant lymphoma (Bcell, diffuse medium-sized cell type). We considered it was primary lung tumor because there was no lesion in other organs. She has been well for four years. We reported it with a review of the literature in Japan.
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  • Yasuhiro Suzuki, Makoto Oumi, Motoo Takahashi, Toshiaki Kawakami, Miri ...
    1998 Volume 12 Issue 6 Pages 712-716
    Published: September 15, 1998
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    Here we report a case of leiomyosarcoma of the lung which is a rare disease. A 75-year-old man underwent left lower lobectomy in December 1990. First recurrence was found in the lower mediastinum in June 1992. Second recurrence was 10th rib and vertebral metastasis in January 1995. Third recurrence was both lung and left rib metastasis in December 1995. These recurrences were resected. 5 years and 10 months after first surgery, he died of multiple metastases (multiple lung and liver metastases, pleural and peritoneal dissemination, etc) in October 1996. Principal therapy for leiomyosarcoma of the lung is surgical resection. The same may be true of management for metastatic leiomyosarcoma as long as resection is possible.
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  • Yoshiaki Narita, Yoshinori Suzuki, Yo Kurashima, Toru Nakamura, Toshia ...
    1998 Volume 12 Issue 6 Pages 717-721
    Published: September 15, 1998
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    A 62-year-old male was admitted to our hospital because of an abnormal shadow on a routine chest X-ray. Chest CT scans revealed a well-defined tumor shadow in the left upper lobe. As we suspected malignancy, left upper lobectomy and mediastinal lymphadenectomy was performed. The pathological examination of the resected specimen showed “true” carcinosarcoma made up of large cell carcinoma and rhabdomyosarcoma. Although the prognosis is said to be poor, he is now living and well with no evidence of recurrence of the disease for more than five years.
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  • Katsuyuki Ichiki, Sigeki Sugiyama, Hiroiku Hara, Yosinori Doki, Tomohi ...
    1998 Volume 12 Issue 6 Pages 722-725
    Published: September 15, 1998
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    We reported a case of synchronous left lung lower lobectomy and right S6 segmentectomy for bilateral lung cancer with some literatures. A 64 year-old female consulted us for a left lung cancer noted on her chest rentogenogram. Her computed tomography scanning revealed another tumor in her right lower lobe. Following diagnosis of the right tumor by thoracoscopic needle biopsy, we performed right S6 segmentectomy for this tumor. And then we performed left lower lobectomy and mediastinal lymph node dissection for the left lung cancer. Her postoperative pathological finding was bronchioloalveolar carcinoma of the right lung and papillary adenocarcinoma of the left lower lobe. She did well postoperatively without respiratory support. She was discharged on the 50th postoperative day after receiving adjuvant chemotherapy.
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  • Akira Yamanaka, Toshio Fujimoto, Takashi Hirai
    1998 Volume 12 Issue 6 Pages 726-729
    Published: September 15, 1998
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    A rare case of a 56-year-old man in whom a mediastinal lymphangioma was incidentally detected for the first time by an annual chest check up with CT is presented here. Chest CT and MRI revealed a cyst in the upper mediastinum between SVC and trachea. The 2 cm-sized cyst localized in the mediastinal adipose tissue was completely extirpated with thoracoscopic procedure. The pathological diagnosis was cystic lymphangioma with serous fluid. He was discharged on the 11th postoperative day and is doing well without any complications 32 months postoperatively. The mediastinal lymphangioma of this case is unique as one of early stage, which suggests the site of its origin in the mediastinum, in addition to being a successful one extirpated by thoracoscopic surgery.
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  • Tetsuji Fukuhara, Shigeki Makihara, Yoshiki Umemori, Masato Onishi
    1998 Volume 12 Issue 6 Pages 730-734
    Published: September 15, 1998
    Released: November 11, 2009
    JOURNALS FREE ACCESS
    Three cases of Inflammatory pseudotumor of lung were reported.
    Case 1 was a 67-year-old female who had a small nodule in the left S8 with spicula and pleural indentation. She underwent thoracotomy.
    Case 2 was a 35-year-old female who had a coin lesion in the right S6 with enlargement, and underwent lobectomy.
    Case 3 was a 56-year-old female who had a small nodule in the right S5 with spicula, and underwent video assisted thoracic surgery (VATS).
    Complete removal should be performed for this disease to prevent local recurrence. But it is also important to choose the least invasive procedure as VATS.
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